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1 <br />~ . <br />" (Pague~ 2) <br />MITIE ID # OR PROSPECTING ID/~# 17~~ t1)~ 0.~~" <br />INSPECTION DATE ~' ~ q I Q ~ INSPECTOR'S INITIALS~~ <br />OBSERVATIONS <br />C~ ~~. ~ ~~~.-1 ev1 6 ~ t q - q S. <br />'~'~~ ~ '~~ °~- ~ ; Oct Arv~ • ~ ~' ~eu^ K O.~d. nn 4.v~r~'o,M <br />µ~,~,,, <br />C'`R~ ~ ~` r~G,,~ ~" ~c5'o-~n ~e.c~. G 1-k~ Cru,~~, <br />~ o.sto.~ c~~ns~t ~b'-m.a,~,a~ wn.,o t~na~~.:~.~n{~ <br />~4 ~ °`Sl'uri~ ~ ab ~ r1 `'S 6 0 .~ltw~,~t,~,~ynn w ~u,ca <br />~~ ~ s~ <br />~~-,,,L -~r.9 r~cv.~.-E-v~%~,o~ ~tMC~i~ , -~-f~ ~ .~ns~~eN- .~~~J~t~.~,~.-~'~'c <br />~~~~ <br />~ ~ 4~&~s-L~ ~ p~}~ ~d t~'~ IZ S L.c~-~l w~crw-~ed.1- ~~ c~ ~ <br />~`,~-w~. --(~~ ~ ~ ~b~1~.~~-mot 'a~°~~-ten <br />I 6 E Contact Address - cc: ^ CE <br /> ^ BL <br />NAME ^ FS <br /> ^ HW <br />OPERATOR ^ HMWMD (CH) <br /> ^ SE <br />STREET ^ WQCD (CH) <br /> ^ OTHER <br />CITY/STATE/ZIP <br />